The Chief Operating Officer, Barking, Havering and Redbridge University Hospitals NHS Trust will present to the Sub-Committee on how the Trust is coping with winter pressures on it services.
Minutes:
BHRUT had recently seen a marked increase in patients presenting at the Emergency Department (ED). The winter peak period had begun in November 2016 and was still ongoing. The department saw up to 550 patients per day and the lack of a substantive workforce in the ED was also a problem. A lot of bank and agency staff were used in the ED which was a financial pressure for the Trust.
More patients with respiratory problems were seen during cold weather although the Trust had not seen any Major outbreaks of Influenza or the Norovirus as yet.
Other impacts on the Trust of winter conditions included icy conditions leading to an increase of fractures etc, potential problems with electricity and gas supplies and schools closing due to snow which impacted on nursing staff etc with families. This meant it was important to communicate effectively with the public in order to direct them to the most appropriate place for their care.
Staffing across both hospital sites was reviewed three times a day and staff were moved between sites if necessary. There was 24:7 consultant cover at Queens ED and this was available four days per week at King George. Conference calls were also held on a daily basis with health and social care partners to discuss how pressures could be alleviated. Across the Christmas period, these conference calls were held on a London-wide basis.
The most challenging weeks for the Hospitals’ Trust had been 2-8 January where additional beds had been opened in the community and it was felt that all organisations involved has worked well together over this period. Most ambulance patients were now handed over to a clinical member of staff in the ED within 30 minutes. The winter pressures work undertaken by BHRUT had recently received praise in the Health Service Journal.
Compared to two years ago, there had been a 23% rise in the number of patients attending the ED and a 19% rise in the numbers arriving by ambulance. Fewer patients were however being admitted to hospital via the ED. The rise in ED patients was due to a range of reasons including a lack of GP appointments in some cases and in others, people having seen their GP and wanting a second opinion. Other sections of the diverse population locally were unused to the GP system.
A redirection process had been established as many people who arrived in the ED could be more effectively treated in a pharmacist, walk-in centre or could wait to see their GP. This had allowed around 120 patients per day to be redirected from the ED, approximately 25% of the total. Details of the NHS 111 service were also given to patients attending the ED but officers agreed that consideration also needed to be given to how the NHS 111 service worked.
The redirection service did not run overnight and during this period all patients were assessed in the ED with the sickest patients treated first. There was normally only one ED consultant available overnight and it was therefore necessary to manage demand in this way.
The Sub-Committee NOTED the position.